Towards actionable knowledge: A systematic analysis of mobile patient portal use

As the aging population grows, chronic illness increases, and our healthcare costs sharply increase, patient portals are positioned as a central component of patient engagement through the potential to change the physician-patient relationship and enable chronic disease self-management. A patient’s engagement in their healthcare contributes to improving health outcomes, and information technologies can support health engagement. In this chapter, we extend the existing literature by discovering design gaps for patient portals from a systematic analysis of negative users’ feedback from the actual use of patient portals. Specifically, we adopt a topic modeling approach, latent Dirichlet allocation (LDA) algorithm, to discover design gaps from online low rating user reviews of a common mobile patient portal, EPIC’s mychart. To validate the extracted gaps, we compared the results of LDA analysis with that of human analysis. Overall, the results revealed opportunities to improve collaboration and to enhance the design of portals intended for patient-centered care. Incorporating these changes may enable the technologies to have stronger position to influence health improvement and wellness

A super-Earth and a sub-Neptune orbiting the bright, quiet M3 dwarf TOI-1266

We report the discovery and characterisation of a super-Earth and a sub-Neptune transiting the bright ($K=8.8$), quiet, and nearby (37 pc) M3V dwarf TOI-1266. We validate the planetary nature of TOI-1266 b and c using four sectors of TESS photometry and data from the newly-commissioned 1-m SAINT-EX telescope located in San Pedro M\'artir (Mexico). We also include additional ground-based follow-up photometry as well as high-resolution spectroscopy and high-angular imaging observations. The inner, larger planet has a radius of $R=2.37_{-0.12}^{+0.16}$ R$_{\oplus}$ and an orbital period of 10.9 days. The outer, smaller planet has a radius of $R=1.56_{-0.13}^{+0.15}$ R$_{\oplus}$ on an 18.8-day orbit. The data are found to be consistent with circular, co-planar and stable orbits that are weakly influenced by the 2:1 mean motion resonance. Our TTV analysis of the combined dataset enables model-independent constraints on the masses and eccentricities of the planets. We find planetary masses of $M_\mathrm{p}$ = $13.5_{-9.0}^{+11.0}$ $\mathrm{M_{\oplus}}$ ($<36.8$ $\mathrm{M_{\oplus}}$ at 2-$\sigma$) for TOI-1266 b and $2.2_{-1.5}^{+2.0}$ $\mathrm{M_{\oplus}}$ ($<5.7$ $\mathrm{M_{\oplus}}$ at 2-$\sigma$) for TOI-1266 c. We find small but non-zero orbital eccentricities of $0.09_{-0.05}^{+0.06}$ ($<0.21$ at 2-$\sigma$) for TOI-1266 b and $0.04\pm0.03$ ($<0.10$ at 2-$\sigma$) for TOI-1266 c. The equilibrium temperatures of both planets are of $413\pm20$ K and $344\pm16$ K, respectively, assuming a null Bond albedo and uniform heat redistribution from the day-side to the night-side hemisphere. The host brightness and negligible activity combined with the planetary system architecture and favourable planet-to-star radii ratios makes TOI-1266 an exquisite system for a detailed characterisation

Leptin Administration Favors Muscle Mass Accretion by Decreasing FoxO3a and Increasing PGC-1α in ob/ob Mice

Absence of leptin has been associated with reduced skeletal muscle mass in leptin-deficient ob/ob mice. The aim of our study was to examine the effect of leptin on the catabolic and anabolic pathways regulating muscle mass. Gastrocnemius, extensor digitorum longus and soleus muscle mass as well as fiber size were significantly lower in ob/ob mice compared to wild type littermates, being significantly increased by leptin administration (P<0.001). This effect was associated with an inactivation of the muscle atrophy-related transcription factor forkhead box class O3 (FoxO3a) (P<0.05), and with a decrease in the protein expression levels of the E3 ubiquitin-ligases muscle atrophy F-box (MAFbx) (P<0.05) and muscle RING finger 1 (MuRF1) (P<0.05). Moreover, leptin increased (P<0.01) protein expression levels of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), a regulator of muscle fiber type, and decreased (P<0.05) myostatin protein, a negative regulator of muscle growth. Leptin administration also activated (P<0.01) the regulators of cell cycle progression proliferating cell nuclear antigen (PCNA) and cyclin D1, and increased (P<0.01) myofibrillar protein troponin T. The present study provides evidence that leptin treatment may increase muscle mass of ob/ob mice by inhibiting myofibrillar protein degradation as well as enhancing muscle cell proliferation

Assessing the Potential of Regulating Ecosystem Services as Nature-Based Solutions in Urban Areas

Mounting research assesses the provision of regulating ecosystem services by green infrastructure in urban areas, but the extent to which these services can offer effective nature-based solutions for addressing urban climate change-related challenges is rarely considered. In this chapter, we synthesize knowledge from assessments of urban green infrastructure carried out in Europe and beyond to evaluate the potential contribution of regulating ecosystem services to offset carbon emissions, reduce heat stress and abate air pollution at the metropolitan, city and site scales. Results from this review indicate that the potential of regulating ecosystem services provided by urban green infrastructure to counteract these three climate change-related pressures is often limited and/or uncertain, especially at the city and metropolitan levels. However, their contribution can have a substantially higher impact at site scales such as in street canyons and around green spaces. We note that if regulating ecosystem services are to offer effective nature-based solutions in urban areas, it is critically important that green infrastructure policies target the relevant implementation scale. This calls for a coordination between authorities dealing with urban and environmental policy and for the harmonization of planning and management instruments in a multilevel governance approach. Regulating ecosystem services • Urban green infrastructure • Global climate regulation • Local climate regulation • Air quality regulation • Multi-scale assessmentpublishedVersio

Molecular markers and genetic diversity of Plasmodium vivax

Enhanced understanding of the transmission dynamics and population genetics for Plasmodium vivax is crucial in predicting the emergence and spread of novel parasite phenotypes with major public health implications, such as new relapsing patterns, drug resistance and increased virulence. Suitable molecular markers are required for these population genetic studies. Here, we focus on two groups of molecular markers that are commonly used to analyse natural populations of P. vivax. We use markers under selective pressure, for instance, antigen-coding polymorphic genes, and markers that are not under strong natural selection, such as most minisatellite and microsatellite loci. First, we review data obtained using genes encoding for P. vivax antigens: circumsporozoite protein, merozoite surface proteins 1 and 3α, apical membrane antigen 1 and Duffy binding antigen. We next address neutral or nearly neutral molecular markers, especially microsatellite loci, providing a complete list of markers that have already been used in P. vivax populations studies. We also analyse the microsatellite loci identified in the P. vivax genome project. Finally, we discuss some practical uses for P. vivax genotyping, for example, detecting multiple-clone infections and tracking the geographic origin of isolates

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

On the early irrigation of gypseous lands in Spain

2 Files (11 Pags., 18 Pags.). The second file is the Supplementary material published with the article. This supplementary material is the transcript of a typewritten Report, in Spanish, authored by F. de los Ríos. This transcription was made by J. Herrero from a badly damaged carbon copy on onionskin paper. The definitive version is available at: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-145XGypseous lands occur mainly in arid regions of the world, where irrigation is required for profitable agriculture. The study of gypseous soils has been neglected for years in the main stream of the soil science. Agriculture and, more recently, the environmental concerns are challenging research in the countries that have extensive gypsum outcrops. Those challenges have been obvious since at least the 1960s, when economic development in some of these countries led to the construction of new irrigation schemes and associated infrastructures. This paper presents examples of documents about agriculture on gypseous soils in Spain that might be applicable to similar situations elsewhere in the world.This work has been funded by the Spanish Government under the project CGL2015-71360-P and by the Spanish National Research Council (CSIC) under the project Icoop-2016SU0015.Peer reviewe